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Evidence Update Issue 22, 2020| October 8, 2020 |
PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS
Teacher training organisations and their preparation of the pre-service teacher to deliver comprehensive sexuality education in the school setting: a systematic literature review. Heidi O'Brien, Jacqueline Hendriks and Sharyn Burns. Culture, Health & Sexuality. This study explored the extent to which organisations responsible for initial teacher training, prepare pre-service teachers to deliver comprehensive sexuality education in schools. Overall, information regarding training in comprehensive sexuality education for pre-service teachers is limited.The current provision does not appear to align with international and best-practice guidelines in most instances.
HIV stigma by association among Australian gay and bisexual men. Timothy Broady, Loren Brener, Max Hopewood, Elena Cama, Carla Treloar, Martin Holt. AIDS. This article examines HIV stigma by association among Australian gay and bisexual men (GBM) using a cross-sectional study. The results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations.
Seizing the Moment - Tackling entrenched inequalities to end epidemics. UNAIDS This report on the global AIDS epidemic shows that 2020 targets will not be met. Missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. The response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services. This report provides an overview of 2020 commitments, impact of the pandemic, approaches for the future and region profiles.
COVID-19 and HIV: 1 moment, 2 epidemics, 3 opportunities—how to seize the moment to learn, leverage and build a new way forward for everyone’s health and rights. UNAIDS. This report examines how the experience of tackling HIV can help inform and guide effective, efficient, people-centred and sustainable COVID-19 responses. Key learnings and recommendations are made.
Aboriginal Community Controlled Health Organisations in practice: Sharing ways of working from the ACCHO sector. South Australian Health and Medical Research Institute. This report was developed to share the findings of Aboriginal and Torres Strait Islander led research undertaken during 2014 – 2019 by the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE), Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute. It showcases the work of Aboriginal community-controlled health organisations (ACCHOs) in practice in order to strengthen the ACCHO sector nationwide.
Ask the Specialist: Larrakia, Tiwi and Yolŋu stories to inspire better healthcare. Menzies School of Health Research. Ask the Specialist is a cultural education podcast which answers doctors’ questions about working with Aboriginal patients at Top End hospitals. In this edition, “The Specialists” are Larrakia Elder Bilawara Lee, Tiwi Elder Pirrawayingi Puruntatameri and Yolŋu leader Rarrtjiwuy Melanie Herdman.
Sexual Health Matters - Clinical Podcast. Shine SA. This podcast series broaches the uncomfortable topics necessary to ensure client safety and sexual/reproductive well-being. The latest episode discusses the importance of GPs regularly screening their patients for chlamydia while elaborating on the why, when, and how.
BMJ STI Podcast, HIV and COVID-19 - what do we know so far? This edition of the podcast provides an update on the current recommendations on the clinical management of people living with HIV that may require hospitalisation due to COVID-19 infection.
Exploration of the Complex Relationships Among Multilevel Predictors of PrEP Use Among Men Who Have Sex with Men in the United States. The study aimed to explore the relationships among individual, social, and contextual level factors and pre-exposure prophylaxis (PrEP) use. A cross-sectional survey was conducted in 2015–2016 among a geographically diverse group of men who have sex with men (MSM) in the United States of America (USA). After data analysis, it was found that residents of states in the USA with high lesbian, gay, bisexual, trans, queer (LGBTQ +) equality had significantly higher odds of taking PrEP compared to low equality states. LGBTQ + inequality between states may hinder PrEP use, and states may need to take proactive measures to reduce LGBTQ + inequality.
Perspectives from Young Partnered Gay, Bisexual, and Other Men Who Have Sex with Men on the Adaptation of Couples HIV Testing and Counseling (CHTC). The researchers explored partnered Young, Gay, Bisexual and Other Men who have Sex with Men (YGBMSM) perceptions of existing HIV prevention interventions to inform the design of a relationship-focused HIV prevention intervention. Between July and November 2018, 30 in-depth interviews were conducted. Participants described that interventions were needed to address skills regarding: implicit versus explicit communication about sexual agreements; boundary setting and identifying signs of abusive relationships; and relationship dynamics (e.g., trust). Participants noted the absence of inclusive sexual education for them; thus, findings suggest that the provision of relationship skills training are requisites for HIV prevention interventions with YGBMSM in the US.
Australian Journal of General Practice
Facilitating hepatitis B clinical management in general practice. The aim of this study was to identify elements supporting hepatitis B (HBV) related clinical management in primary care settings. Data from qualitative semi-structured interviews with participants from primary care settings were thematically analysed. Critical elements in providing clinical care in primary care settings were identified at an organisational and provider level. A supportive organisational culture included leadership, a multidisciplinary team approach, community engagement and cultural competency, while provider-related issues included authorisation to prescribe, access to linguistic and cultural mediators and effective relationships with relevant specialist services.
Culture, Healthy & Sexuality
Desiring intimacy and building community: young, gay and living with HIV in the time of PrEP. This study explores the effect of PrEP adoption on the lives of men living with HIV in one of the first cities that made PrEP widely available,San Francisco, and where adoption had already been in place in treatment trials prior to Food and Drug Administration approval in 2012. Interviews were conducted with under 40 year olds in San Francisco. The findings suggest that, post-PrEP rollout, men living with HIV are experience dating, sex and community in ways that reflect a general reduction in the experience of stigma surrounding their HIV status. This suggests an important social impact of PrEP in reducing HIV-related stigma beyond the primary prophylactic effect.
Characterising the structure of the largest online commercial sex network in the UK: observational study with implications for STI prevention. This study examined online data to explore the characteristics of a national commercial sex network of off-street female sex workers. Sexual contact information was collected from the largest online community dedicated to reviewing sex workers’ services in the United Kingdom (UK). A sexual network was then built using reviews reported between January 2014 and December 2017. It was found that few clients and sex workers are highly connected whilst the majority only have one or few sexual contacts. Interventions can be focusing on the most active members (whether sex workers or clients) using the network to reduce disease transmission.
“You put yourself at risk to keep the relationship:” African American women’s perspectives on womanhood, relationships, sex and HIV. The study used Collins’ Black Feminist Thought to examine and understand attitudes and perceptions around HIV and sexual risk behaviours among African American women aged 50 years and older, through focus groups. Participants were recruited from two faith-based organisations in the mid-Atlantic region of the USA. Overarching themes and subthemes included those of expectations among African American women (carry yourself as you were raised, and carry a big burden), risk factors (not at risk, sexual networks and loneliness) and protective factors (maintaining high standards and education). Findings from this study have implications for the development of future HIV prevention programs involving older African American women, who have largely been overlooked by past and ongoing HIV prevention trials and safer sex promotion efforts.
Harm Reduction Journal
A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South. The study aimed to understand why people diagnosed with hepatitis C virus (HCV) have not pursued care in the non-urban United States of America. A survey and interview were conducted with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate the pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may increase access to HCV treatment.
HaRePo (harm reduction by post): an innovative and effective harm reduction programme for people who use drugs using email, telephone, and post service. The researchers tested an approach using the remote online communication and the national postal distribution network in France to improve harm reduction tool access and counselling. People who use drugs (PWUD) could access the program by phone and/or email, where harm reduction (HR) professionals delivered HR counselling and tools and connected PWUD to other HR services, medical, and social workers. HR tools were then prepared and sent according to the person’s needs through the French postal service across Metropolitan France and overseas territories. Since 2011, 1,920 PWUD have benefited from the program, receiving positive feedback and high use from PWUD who have improved their practices through remote but trusted communication. HaRePo is efficient for hard-to-reach PWUD.
Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching. This study examines the relationship between methamphetamine (MA) use and HIV risk behaviour among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching. Data for these analyses were derived from a cross-sectional study conducted between June and July 2016. The results found a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased needle syringe sharing, which is associated with higher risk for HIV exposure and transmission.
International Journal of Drug Policy
‘Peer’ work as precarious: A qualitative study of work conditions and experiences of people who use drugs engaged in harm reduction work. The study examined the qualitative accounts of people who use drugs engaged in ‘peer’ work in harm reduction settings across British Columbia, Canada. In 2017–2018, data were collected from fifteen one-on-one qualitative interviews with PWUD recently engaged in peer work. It was found that peer work is precarious in both its dimensions and experience. Peer work is not impermeable to the social, economic and labor inequities that PWUD face in labor contexts. Moving forward, the work conditions of PWUD should be a key indicator of equity in harm reduction work.
Estimating the Consensus hepatitis C Cascade of Care among people who inject drugs in Australia: Pre and post availability of direct acting antiviral therapy. This study aimed to estimate the Consensus hepatitis C cascade of care (COC) among PWID using data collected in Australia prior to and after the introduction of unrestricted direct-acting antiviral (DAA) therapy in March 2016. Among an estimated 75,000 people who inject drugs on a regular basis in Australia, the number with active HCV infection declined. This study demonstrates remarkable HCV COC progress among PWID in Australia following availability of DAA therapy. Estimates of the Consensus hepatitis C COC among PWID are required to monitor progress toward World Health Organization HCV elimination goals.
International Journal of STD & AIDS
Missed opportunities within healthcare for an earlier diagnosis of HIV. The researchers discuss the clinical impact of missed HIV testing, and options for remediation. Clinical encounters prior to HIV diagnosis including the discharge diagnosis were collected between 2011 and 2016 in Alberta, Canada. Data was encoded and statistical analysis performed. Findings suggest protocols beyond the current recommendations are urgently required to address missed HIV diagnostic opportunities who engaged healthcare.
Exploring associations between place of sex work and HIV vulnerabilities among sex workers in Jamaica. The researchers applied the Structural HIV Determinants Framework to examine associations between the work environment of public spaces and HIV infection risks among sex workers in Jamaica. This considers macro-structural (police harassment) and intrapersonal (depression) pathways. A cross-sectional survey was conducted with sex workers. Results indicate that public place of sex work had a significant indirect effect on self-reported HIV-positive serostatus; depression and police harassment mediated this relationship. Findings suggest that in contexts of criminalisation, the sex work environment can elevate exposure to police violence and depression, in turn increasing HIV vulnerabilities.
A home-practice intervention for increasing condom use among university undergraduates. This study evaluated a sex-positive, home-practice intervention designed to promote condom use among university undergraduates engaging in penile–vaginal intercourse (PVI). Opposite-sex undergraduate couples, engaging in PVI, were recruited from a large university. After teaching couples about condom use, a health educator helped couples select condoms/lubricants. A 30-day ‘homework assignment’ was made to use these products while reducing condom use errors/problems and enhancing sexual pleasure. Most students completing the follow-up assessment indicated the intervention would favourably impact their future condom use. Findings suggest this intervention program may be important to promoting condom use among university couples engaging in PVI.
Awareness and use of HIV pre-exposure prophylaxis among people who engage in sex work presenting to a sexually transmitted infection clinic. The study evaluated HIV risk factors, sexual health history, PrEP awareness, and PrEP use among individuals reporting sex work who presented to a publicly funded STI clinic in Rhode Island, USA. Quantitative data was collected from participants and statistically analysed. The study found higher rates of risk behaviours among sex workers than non-sex workers. Improved efforts are needed to understand the multiple, intersecting factors related to PrEP awareness and use and to improve the PrEP care continuum among this marginalized population.
Journal of Medical Internet Research
Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study. The aim was to assess the role of a peer-customised mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among MSM, transgender women, and PWUD in Indonesia. A pre-post assessment survey was conducted on a sample of 200 unique users, and a Health app named RUMAH SELA was developed and implemented among the key populations. From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge. The mHealth app was found to be effective in increasing HIV-related knowledge and behavior, and access to services, with strong acceptability by the community
eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey. The study aim was to assess electronic data security confidence level, electronic communication behaviours, and interest in using eHealth communication tools with clients of staff at community-based HIV/AIDS service organizations, through a survey. Participants had some level of confidence that safeguards were in place to keep electronically shared information from being seen by other people. It is very likely that eHealth communication tools can be used in community settings to improve health outcomes across the HIV care continuum. More research is recommended.
Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research. This paper aimed to explore perceptions and experiences of internet-based testing for STIs among users and potential users. Searches were run through 5 electronic databases to identify peer-reviewed studies published between 2005 and 2018. The synthesis identified that internet-based testing is viewed widely as being acceptable and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There is a clear need for further research exploring in-depth the perceptions and experiences of users.
Journal of Acquired Immune Deficiency Syndromes
Outcomes Among HIV-Positive Patients Hospitalized With COVID-19. A retrospective matched cohort study was conducted to characterise outcomes in HIV-positive patients with SARS-CoV-2 infection. Data were collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March and April 2020. Twenty-one HIV-positive patients and 42 non-HIV patients were compared on admission characteristics, laboratory test results, and hospital outcomes. There was a trend toward increased rates of intensive care unit admission, mechanical ventilation, and mortality in HIV-positive patients, but these differences were not statistically significant. This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared with matched non-HIV patients.
Journal of the International AIDS Society
Combating HIV stigma in low‐ and middle‐income healthcare settings: a scoping review. The study reviewed existing research on the effectiveness of stigma interventions in healthcare settings of low‐ and middle‐income countries (LMIC), where stigma control efforts are often complicated by HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalised identities. From 4 databases, 19 studies were included for review. Studies demonstrated broad regional distribution of stigma reduction studies across LMIC and many employed designs that made use of a control condition. Combating healthcare stigma in LMIC requires interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma.
Journal of Viral Hepatitis
Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or “re‐diagnose” infections is effective in Australia. The study assessed the effectiveness of an automated Emergency Department screening service in identifying patients with hepatitis C (HCV) and achieving linkage to care. An evaluation was conducted on the first 5000 patients screened through an automatic Australian service. Screening captured those recommended in the Australian national testing policy, specifically overseas-born and Aboriginal or Torres Strait Islanders Peoples. The evaluation found that automated viral hepatitis testing of patients presenting to Emergency Departments utilising an opt-out consent adetects high rates of viral hepatitis.
Patient-delivered partner therapy for chlamydia in Australia: can it become part of routine care? The study explored the policy environment for patient-delivered partner therapy (PDPT) for chlamydia in Australia and considered how PDPT might become a routine option. Interviews were conducted with 10 key informants (KIs) representing six Australian jurisdictions. Documents relevant to PDPT were appraised. PDPT was allowable in three states: Victoria, New South Wales and the Northern Territory, where State governments have formally supported PDPT. In Western Australia, the Australian Capital Territory and Tasmania, KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT with respect to professional standards and regulatory requirements.
Sexually Transmitted Infections
Early impact of COVID-19 social distancing measures on reported sexual behaviour of HIV pre-exposure prophylaxis users in Wales. The study aimed to describe the early impact of COVID-19 and associated control measures on the sexual behaviour of PrEP users in Wales. Data were obtained from an ecological momentary assessment study of PrEP use and sexual behaviour. Participants were individuals accessing PrEP through the National Health Service (NHS) sexual health clinics across four health boards in Wales. The introduction of social distancing measures and changes to PrEP services across Wales was associated with a marked reduction in reported instances of condomless sexual intercourse among respondents, with a larger reduction in those who were single compared with those who were not. The long-term impact of COVID-19 and associated control measures on this population’s physical and mental health and well-being requires closer examination.